Nephrotic syndrome causes severe hypercholesterolaemia due to increased production and altered clearance of lipoproteins from the liver. It is challenging for patients with nephrotic syndrome and coronary heart disease to meet LDL-cholesterol (LDL-C) goals for secondary prevention with conventional lipid-lowering therapy.
We present a man with nephrotic syndrome caused by focal segmental glomerular sclerosis (FSGS) and hypercholesterolaemia. He presented at the emergency room (ER) with an ST-elevation myocardial infarction at the age of 26. On follow-up, the patient had persistent hypercholesterolaemia [LDL-C 3.9?mmol/L and lipoprotein(a) 308?nmol/L] despite a combination of lipid-lowering therapy with atorvastatin 80?mg/day and ezetimibe 10?mg/day. https://www.selleckchem.com/products/eidd-2801.html Addition of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitory antibody evolocumab 140?mg bi-monthly did not improve cholesterol levels. However, after addition of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin 10?mg/day oerapy. The SGLT2-inhibitor reduced proteinuria and, speculatively, also reduced urinary loss of PCSK9-antibody. Therefore, in patients with nephrotic syndrome and cardiovascular disease novel therapeutic options to manage proteinuria could be considered to improve the efficacy of the lipid-lowering therapy, especially when the protein-based PCSK9 inhibitors are used.Dobutamine stress echocardiography (DSE) in classical low-flow, low-gradient (LFLG) aortic stenosis (AS) is recommended in recent guidelines to differentiate true-severe AS from pseudo-severe AS. However, DSE for patients with concomitant significant mitral regurgitation (MR) is often inaccurate or inconclusive.
A 73-year-old man with a history of coronary artery bypass grafting was referred to our institution with congestive heart failure. Transthoracic echocardiogram showed severe functional MR and LFLG AS. The results of DSE to determine the severity of AS were inconclusive owing to the absence of flow reserve, usually defined as stroke volume increase of ?20%. In addition, calcium score by computed tomography scan was also inconclusive. Our heart team decided to reassess the severity of AS after percutaneous edge-to-edge mitral valve repair (PMVR), considering the patient's high surgical risk. Percutaneous edge-to-edge mitral valve repair was uneventful, resulting in marked reduction of MR from severemay worsen MR and fail to increase the stroke volume. In our case, DSE after PMVR was useful to diagnose the true-severe AS for the patient with LFLG AS and severe functional MR.Coronary flow compromise is a significant risk of transcatheter aortic valve therapy. Warranting preservation of coronary flow is even more challenging with transcatheter aortic valve re-intervention since the implantation of a transcatheter valve within a degenerated bioprosthetic or transcatheter valve increases significantly this hazard.
We present a case of heart failure secondary to transcatheter aortic valve degeneration requiring a transcatheter aortic valve re-intervention. Pre-operative imaging studies demonstrated a high risk for iatrogenic coronary flow impairment. The patient underwent a successful surgical removal of the prosthetic valve leaflets followed by direct transcatheter aortic valve implantation.
We reviewed the literature on the approach to difficult coronaries in transcatheter aortic valve therapy, and we describe an innovative hybrid approach that may represent a viable alternative in cases where catheter techniques of coronary flow preservation are not applicable.
We reviewed the literature on the approach to difficult coronaries in transcatheter aortic valve therapy, and we describe an innovative hybrid approach that may represent a viable alternative in cases where catheter techniques of coronary flow preservation are not applicable.Triangular ST-segment elevation or 'shark-fin' sign has been described as a specific indicator of acute coronary occlusion and large myocardial ischaemia, translating into poorer prognosis. However, this electrocardiographic presentation has been reported in rare cases of Tako-Tsubo syndrome and associated with more severe physical stressors and neurological involvement.
We present a rare case of a 51-year-old woman presenting with incoming epileptic attacks and concomitant pyometra. Despite controlling epilepsy with phenytoin and the surgical treatment of the infection, she developed sepsis requiring vasopressors, and thereafter sustained ventricular tachycardia and diffuse ST-segment elevation with the 'shark-fin' sign. TTC was confirmed by the documentation of normal coronary arteries and the complete recovery of wall motion abnormalities at discharge.
Heterogeneous presentation and triggering conditions often challenge the diagnosis of Tako-Tsubo syndrome. The acknowledgement of different electrocardiographic and clinical manifestations can ease the diagnosis and the successful management of these patients, whose prognosis can be extremely severe in the acute phase, if unidentified.
Heterogeneous presentation and triggering conditions often challenge the diagnosis of Tako-Tsubo syndrome. The acknowledgement of different electrocardiographic and clinical manifestations can ease the diagnosis and the successful management of these patients, whose prognosis can be extremely severe in the acute phase, if unidentified.Coronary artery pseudoaneurysm is a rare disease that can rupture and cause haemopericardium. It can occur principally as a complication after coronary artery instrumentation, but it can also result from trauma.
A 15-year-old male patient with a history of spontaneous pneumothoraces treated twice with video-assisted thoracoscopic thoracic surgery presented with pericarditis and increasing haemopericardium. During the hospitalization, he had developed cardiogenic shock and he underwent emergent pericardiocentesis. Coronary angiography revealed a small right coronary artery pseudoaneurysm. We successfully coil embolized the pseudoaneurysm.
This is a rare case of a ruptured coronary artery pseudoaneurysm associated with prior tube thoracostomy. The treatments for a coronary pseudoaneurysm should be tailored based on the pathologic and anatomical characteristics.
This is a rare case of a ruptured coronary artery pseudoaneurysm associated with prior tube thoracostomy. The treatments for a coronary pseudoaneurysm should be tailored based on the pathologic and anatomical characteristics.